Treating Highly Complex Anal Fistula With A New Method Of Combined Introperative Endoanal Ultrasonography (IOEAUS) And Transanal Opening Of Intersphincteric Space(TROPIS)

Background: Treatment of high complex anal fistula(HCAF)is always a profound test for specialist colorectal surgeon.Reasons are directly related to cure and continence.Transanal opening of intersphincteric space(TROPIS),as a new surgical approach to retain the anal sphincter,has a good therapeutic effect,but there are improvements in the management of bent,slender,branching fistulas and postoperative drainage.Therefore,we combined Intraoperative endoanal ultrasonography(IOEAUS)and TROPIS to solve these problems.Aim: To evaluate the clinical results of a combined method of introperative endoanal ultrasonography(IOEAUS)and transanal opening of intersphincteric space(TROPIS).Including cure rate,postoperative anal function and complications.Material and methods: This study retrospectively analyzed 48 cases of complex anal fistula patients treated by IOEAUS combined TROPIS in the First Hospital of Jilin University from October 2017 to December 2019.This procedure consists of two main steps.First,preoperative endoanal ultrasonography(EAUS)or MRI were used to determine the type of anal fistula,and eligible patients were screened and included for surgical treatment.Then TROPIS assisted by ultrasound was performed,and a drainage seton was placed according to the type of anal fistula.Postoperative follow-up was conducted to record the wound healing,complete healing time,number and time of recurrence,postoperative complications such as pain,bleeding,etc.Wexner incontinence score and anorectal manometric pressure were used to evaluate anal function before and 6 months after operation,respectively.Results: The mean follow-up time was 12 months.All 48 patients had no followup loss.42(87.5)patients received primary healing.There were 2(4.1%)patients of recurrence and 4(8.3%)of false healing.The 6 patients underwent the same surgical procedure,and 3 of them healed completely.Thus,the overall success rate of fistula recovery was 45(93.7%).There was no significant statistical difference between each subgroup(P>0.05).All the patients had no serious complications such as infection spread or abscess formation.Postoperative rectal bleeding occurred in 3 patients,including 2 patients who received compression hemostasis and 1 patient who received bleeding suture,all of which were well controlled.1(2.1%)presented urinary retention.The VAS pain score showed that some patients had low grade pain,but severe pain.There were no significant changes in anal function and incontinence scores 6 months after surgery(P>0.05).Conclusions: Combined IOEAUS and TROPIS is an effective surgical method in treatment of high complex anal fistula,which can effectively reduce the risk of postoperative anal incontinence,recurrence rate,postoperative discomfort while ensuring a good cure rate,and it may offer a new means for other operations.